Diabetic Ketoacidosis

Published on February 11, 2018

By : admin

Diabetic Ketoacidosis

In diabetes, blood glucose is not able to reach the body cells where it can be utilized to produce energy. In such cases, the cells start to break down fat to produce energy. This process produces a chemical called ketone.[1] The buildup of ketones makes the blood more acidic. When the blood ketone level gets too high, a condition develops called diabetic ketoacidosis (DKA). It is a serious condition that can lead to coma or even death. DKA can happen to anyone with diabetes though it is more common in people with type 1 diabetes.[2] In this article, we’ll explore the causes, symptoms treatment options, and complications of this life-threatening condition.

Causes of Diabetic Ketoacidosis

DKA results from inadequate insulin levels that cause the cells to burn fat for energy. Ketones are released into the blood when fats are broken down. In people with diabetes, an underlying problem often triggers the onset of DKA. The following problems or conditions may contribute to DKA:

An illness where the body produces higher levels of stress hormones like cortisol or adrenalin; these illnesses have a countereffect on the action of insulin (conditions like pneumonia or a urinary tract infection are common culprits)

Inadequate insulin due to missed doses or more requirements

Alcohol or drug abuse

Less food intake (this could be caused by sickness, fasting, or an eating disorder; bulimia, for example, produces excess ketones)

Medications like corticosteroids and diuretics

Pregnancy

Heart attack [3],[4]

Symptomsof Diabetic Ketoacidosis

Symptoms of DKA typically evolve over a period of 24 hours. Some symptoms to be aware of include the following:

There are some steps you can take to bring down ketone levels in your body:

Treatment of Diabetic Ketoacidosis

The primary aim of treating DKA is to replace the lost fluids and electrolytes in your body. Here are the most common ways that DKA is treated in the hospital:

Fluid replacement – The amount of fluid replenishment depends on the degree of dehydration. If dehydration is severe, then rapid infusion of saline (adults – 1L, children -10ml/kg) is recommended. If DKA is moderate, then saline is infused at a slower rate. A mild case of DKA requires replenishment with oral rehydration.[10], [11], [12]

Insulin therapy – Insulin is generally given through IV in the hospital at a rate of 0.1unit/kg/hr. When your blood glucose levels fall below 240mg/dl, IV insulin should be stopped. Potassium (K+) levels should be maintained at or above 3.3mmol/L as insulin lowers the amount of this mineral in the body. In addition to this treatment, your heart rate should monitored constantly.[12], [13]

Electrolyte replacement – Insulin therapy lowers the level of blood electrolytes, hence they need to be replenished either through IV or oral rehydration.[13]

Before leaving the hospital, be sure to discuss the steps to prevent DKA with your doctor in detail. He or she will likely recommend the following prevention measures for you:

Monitor your blood sugar at least 3-4 times a day or more during times of illness or stress.

Follow your insulin treatment plan.

Take extra care when you are sick and follow the sick day steps discussed with your doctor.

Complications of Diabetic Ketoacidosis

Although the early signs and symptoms of DKA can often be treated through self-care measures or a trip to the hospital, there are some cases in which other complications may develop. Some of these complications are listed below:

Hyperkalemia and hypokalemia (electrolyte disorders)– Severe increases and decreases in the K+ levels during DKA occurrence and treatment can be life-threatening. Therefore, careful monitoring of K+ is essential. Severe dehydration leads to acute pre-renal failure (liver failure) and an increase in K+ If the increase is above 5.5mmol/L, its infusion along with saline is discouraged. Treatment with fluids and electrolytes leads to a decrease in the K+; if the fall is below 5.5mmol/L, then reinfusion with K+ levels should be done.

Cerebral Edema (swelling of the brain caused by excess fluid) – It is the most dangerous complication of DKA, occurring sub-clinically both before and after treatment. It may be due to cerebral hypoperfusion (insufficient blood flow to the brain, which cuts off oxygen supply) with subsequent reperfusion. This critical, life-threatening complication is more common in children than adults.

Pulmonary edema (excess fluid in the lungs)– A rare complication associated with the treatment of DKA. Elderly patients with impaired cardiac function are at a greater risk. [9], [8], [14]

You’ve learned about the causes, symptoms, treatments, and possible complications of DKA. For more information about how to manage your type 1 or type 2 diabetes in an effort to prevent this condition from occurring, check out the latest information at dlife.com.

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